What is causing the comeback of AIDS? Solutions

AIDS was first identified in the early 1980s, with the initial cases reported from the United States. By the 1990s, the disease had spread worldwide. In the early years, there was little understanding of the infection, its modes of transmission or available treatment options. It was only during the 1990s that systematic research into the disease began to gain momentum worldwide.

Over time, clearer insights emerged into the origin of the disease, its spread, and the measures needed for prevention and treatment. Medicines entered the market, offering hope to millions. By the early 2000s, countries around the world, particularly India, were able to significantly reduce both the number of HIV patients and the spread of the disease. Compared to many Western nations, India made notable advances in controlling HIV.

The road to control
By the early 2000s, the production of HIV medicines had increased manifold. At one point, nearly 90 per cent of AIDS medicines used worldwide were manufactured in India. From 2005 onwards, deaths caused by AIDS began to decline sharply, and the rate of transmission from infected individuals to others also fell significantly.

When medicines are taken regularly and correctly, the viral load in the body decreases and eventually reaches a stage where the virus becomes almost negligible. This stage is known as an undetectable viral load. At this point, the risk of transmitting the disease to others drops drastically.

The author personally knows individuals who were born HIV positive and have been on regular medication for over 35 years. They have not required hospitalisation so far. In such cases, personal hygiene, discipline and consistent medical care are crucial.

Programmes such as the National AIDS Control Programme, the National AIDS Control Organisation, the National AIDS Control Strategy, ART treatment, and the efforts of several organisations in this field, along with government initiatives and modern treatment methods, have together played a significant role in bringing AIDS under control. The risk of disease transmission through hospitals has also reduced considerably.

By 2020, the global number of AIDS cases had declined by nearly 60 per cent.
A concerning resurgence
Three significant factors are contributing to what can be described as a second wave of AIDS. The first is drug abuse among youngsters, particularly intravenous drug use involving shared syringes. At present, around 10 per cent of reported cases fall under this category, and the numbers are steadily rising.

The second factor is the spread of infection through unsafe sexual practices among people who have sex with the same gender. Setting aside debates on the moral or ethical aspects of this practice, nearly 20 per cent of the AIDS cases currently reported in Kerala are linked to such unsafe practices. Changing social patterns and evolving personal relationships may be contributing to this trend.

While many people are willing to use medicines to prevent pregnancy, there is often reluctance to prioritise safety in sexual relationships. Increased testing has also resulted in more cases being detected and reported. At the same time, a rise in other sexually transmitted infections has also weakened some of the gains made earlier in AIDS control.

The changing scenario in Kerala
In the early years of the epidemic, AIDS cases in India were primarily concentrated in metropolitan cities and Kerala was not considered a high-risk region. Strong awareness of personal hygiene and relatively high levels of education among the population played a key role in keeping the numbers low.

If India is estimated to have around 25 lakh AIDS patients, Kerala accounts for about 25,000 cases. For several years, the state reported fewer than 1,000 cases annually. However, this trend has shifted in recent years.

According to the latest estimates, more than 100 AIDS cases are now being reported in Kerala every month. For a relatively small state, this rise is indeed a cause for concern.

Infographics
Total number of AIDS patients in India: 25.80 lakh
40 per cent of patients are from Andhra Pradesh, Maharashtra and Karnataka
AIDS cases in Kerala
2021 to 22: 1000
2022 to 23: 1183
2023 to 24: 1263
2024 to 25: 1213
2025 to 26: 818
(The author is a professor with the Department of Epidemiology at Kottayam Medical College. He also serves as a National AIDS trainer and is a member of the AIDS Society of India’s Expert Committee.)